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Grigorescu RR, Husar-Sburlan IA, Gheorghe C. Pancreatic Cancer: A Review of Risk Factors. Life (Basel) 2024; 14:980. [PMID: 39202722 PMCID: PMC11355429 DOI: 10.3390/life14080980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/28/2024] [Accepted: 08/01/2024] [Indexed: 09/03/2024] Open
Abstract
Pancreatic adenocarcinoma is one of the most lethal types of gastrointestinal cancer despite the latest medical advances. Its incidence has continuously increased in recent years in developed countries. The location of the pancreas can result in the initial symptoms of neoplasia being overlooked, which can lead to a delayed diagnosis and a subsequent reduction in the spectrum of available therapeutic options. The role of modifiable risk factors in pancreatic cancer has been extensively studied in recent years, with smoking and alcohol consumption identified as key contributors. However, the few screening programs that have been developed focus exclusively on genetic factors, without considering the potential impact of modifiable factors on disease occurrence. Thus, fully understanding and detecting the risk factors for pancreatic cancer represents an important step in the prevention and early diagnosis of this type of neoplasia. This review reports the available evidence on different risk factors and identifies the areas that could benefit the most from additional studies.
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Affiliation(s)
- Raluca Roxana Grigorescu
- Gastroenterology Department, “Sfanta Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | | | - Cristian Gheorghe
- Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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2
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Mishra AK, Chong B, Arunachalam SP, Oberg AL, Majumder S. Machine Learning Models for Pancreatic Cancer Risk Prediction Using Electronic Health Record Data-A Systematic Review and Assessment. Am J Gastroenterol 2024; 119:1466-1482. [PMID: 38752654 PMCID: PMC11296923 DOI: 10.14309/ajg.0000000000002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/06/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Accurate risk prediction can facilitate screening and early detection of pancreatic cancer (PC). We conducted a systematic review to critically evaluate effectiveness of machine learning (ML) and artificial intelligence (AI) techniques applied to electronic health records (EHR) for PC risk prediction. METHODS Ovid MEDLINE(R), Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science were searched for articles that utilized ML/AI techniques to predict PC, published between January 1, 2012, and February 1, 2024. Study selection and data extraction were conducted by 2 independent reviewers. Critical appraisal and data extraction were performed using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. Risk of bias and applicability were examined using prediction model risk of bias assessment tool. RESULTS Thirty studies including 169,149 PC cases were identified. Logistic regression was the most frequent modeling method. Twenty studies utilized a curated set of known PC risk predictors or those identified by clinical experts. ML model discrimination performance (C-index) ranged from 0.57 to 1.0. Missing data were underreported, and most studies did not implement explainable-AI techniques or report exclusion time intervals. DISCUSSION AI/ML models for PC risk prediction using known risk factors perform reasonably well and may have near-term applications in identifying cohorts for targeted PC screening if validated in real-world data sets. The combined use of structured and unstructured EHR data using emerging AI models while incorporating explainable-AI techniques has the potential to identify novel PC risk factors, and this approach merits further study.
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Affiliation(s)
- Anup Kumar Mishra
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Bradford Chong
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Ann L. Oberg
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Shounak Majumder
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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3
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Sarwal D, Wang L, Gandhi S, Sagheb Hossein Pour E, Janssens LP, Delgado AM, Doering KA, Mishra AK, Greenwood JD, Liu H, Majumder S. Identification of pancreatic cancer risk factors from clinical notes using natural language processing. Pancreatology 2024; 24:572-578. [PMID: 38693040 DOI: 10.1016/j.pan.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Screening for pancreatic ductal adenocarcinoma (PDAC) is considered in high-risk individuals (HRIs) with established PDAC risk factors, such as family history and germline mutations in PDAC susceptibility genes. Accurate assessment of risk factor status is provider knowledge-dependent and requires extensive manual chart review by experts. Natural Language Processing (NLP) has shown promise in automated data extraction from the electronic health record (EHR). We aimed to use NLP for automated extraction of PDAC risk factors from unstructured clinical notes in the EHR. METHODS We first developed rule-based NLP algorithms to extract PDAC risk factors at the document-level, using an annotated corpus of 2091 clinical notes. Next, we further improved the NLP algorithms using a cohort of 1138 patients through patient-level training, validation, and testing, with comparison against a pre-specified reference standard. To minimize false-negative results we prioritized algorithm recall. RESULTS In the test set (n = 807), the NLP algorithms achieved a recall of 0.933, precision of 0.790, and F1-score of 0.856 for family history of PDAC. For germline genetic mutations, the algorithm had a high recall of 0.851, while precision and F1-score were lower at 0.350 and 0.496 respectively. Most false positives for germline mutations resulted from erroneous recognition of tissue mutations. CONCLUSIONS Rule-based NLP algorithms applied to unstructured clinical notes are highly sensitive for automated identification of PDAC risk factors. Further validation in a large primary-care patient population is warranted to assess real-world utility in identifying HRIs for pancreatic cancer screening.
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Affiliation(s)
- Dhruv Sarwal
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Liwei Wang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Sonal Gandhi
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Laurens P Janssens
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Adriana M Delgado
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Karen A Doering
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Anup Kumar Mishra
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jason D Greenwood
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Shounak Majumder
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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Madela F, Ferndale L, Aldous C. Diagnostic Differentiation between Pancreatitis and Pancreatic Cancer: A Scoping Review. Diagnostics (Basel) 2024; 14:290. [PMID: 38337806 PMCID: PMC10855106 DOI: 10.3390/diagnostics14030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Pancreatitis, encompassing acute and chronic forms, and pancreatic cancer pose significant challenges to the exocrine tissue of the pancreas. Recurrence rates and complications following acute pancreatitis episodes can lead to long-term risks, including diabetes mellitus. Chronic pancreatitis can develop in approximately 15% of cases, regardless of the initial episode's severity. Alcohol-induced pancreatitis, idiopathic causes, cigarette smoking, and hereditary pancreatitis contribute to the progression to chronic pancreatitis. Chronic pancreatitis is associated with an increased risk of pancreatic cancer, with older age at onset and smoking identified as risk factors. This scoping review aims to synthesise recent publications (2017-2022) on the diagnostic differentiation between pancreatitis and pancreatic cancer while identifying knowledge gaps in the field. The review focuses on biomarkers and imaging techniques in individuals with pancreatitis and pancreatic cancer. Promising biomarkers such as faecal elastase-1 and specific chemokines offer non-invasive ways to assess pancreatic insufficiency and detect early biomarkers for chronic pancreatitis. Imaging techniques, including computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), and positron emission tomography (PET), aid in differentiating between chronic pancreatitis and pancreatic cancer. However, accurately distinguishing between the two conditions remains a challenge, particularly when a mass is present in the head of the pancreas. Several knowledge gaps persist despite advancements in understanding the association between pancreatitis and pancreatic cancer, including the correlation between histopathological grading systems, non-invasive imaging techniques, and biomarkers in chronic pancreatitis to determine the risk of progression to pancreatic cancer, as well as differentiating between the two conditions. Further research is necessary to enhance our understanding of these aspects, which can ultimately improve the diagnosis and management of pancreatitis and pancreatic cancer.
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Affiliation(s)
- Fusi Madela
- Department of Surgery, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (L.F.)
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Hsieh CC, Fu YH, Ku NE, Hsia CC, Hung YT, Hsu TJ, Chen SH, Kuo SJ. The Impact of Chronic Pancreatitis on the Occurrences of Human Cancers: Real-World Data. J Clin Med 2023; 12:5102. [PMID: 37568504 PMCID: PMC10420038 DOI: 10.3390/jcm12155102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Chronic pancreatitis (CP) may induce systemic inflammation, potentially increasing cancer susceptibility. However, the link between CP and extra-pancreatic cancer remains underexplored. Employing Taiwanese National Health Insurance Database data from 2000 to 2017, we compared 5394 CP patients with 21,576 non-CP individuals through propensity score matching. CP patients exhibited a significantly higher cancer risk (adjusted hazard ratio (aHR) of 1.32 for females and 1.68 for males) and cumulative incidence (p < 0.001) compared to non-CP individuals. CP showed notable associations with pancreatic (aHR = 3.51), liver (aHR = 1.62), stomach (aHR = 2.01), and other cancers (aHR = 2.09). In terms of liver cancer, CP was significantly associated with patients without viral hepatitis, regardless of gender (aHR = 2.01 for women; aHR = 1.54 for men). No significant cancer occurrences were observed within the first year following CP diagnosis. Pancreatic or liver cancer developed in approximately half of CP patients within 2-3 years, while gastric cancer in male CP patients predominantly occurred around the fifth year after diagnosis. These findings inform potential cancer-screening plans for CP patients.
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Affiliation(s)
- Chi-Chia Hsieh
- Department of Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Yi-Hsiu Fu
- Department of Education, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Nien-En Ku
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan; (N.-E.K.); (C.-C.H.)
| | - Chia-Chun Hsia
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan; (N.-E.K.); (C.-C.H.)
| | - Yu-Tung Hung
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan; (Y.-T.H.); (T.-J.H.)
| | - Tzu-Ju Hsu
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan; (Y.-T.H.); (T.-J.H.)
| | - Sung-Hsiung Chen
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
| | - Shu-Jui Kuo
- School of Medicine, China Medical University, Taichung 404328, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
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Fu S, Wang L, Moon S, Zong N, He H, Pejaver V, Relevo R, Walden A, Haendel M, Chute CG, Liu H. Recommended practices and ethical considerations for natural language processing-assisted observational research: A scoping review. Clin Transl Sci 2023; 16:398-411. [PMID: 36478394 PMCID: PMC10014687 DOI: 10.1111/cts.13463] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
An increasing number of studies have reported using natural language processing (NLP) to assist observational research by extracting clinical information from electronic health records (EHRs). Currently, no standardized reporting guidelines for NLP-assisted observational studies exist. The absence of detailed reporting guidelines may create ambiguity in the use of NLP-derived content, knowledge gaps in the current research reporting practices, and reproducibility challenges. To address these issues, we conducted a scoping review of NLP-assisted observational clinical studies and examined their reporting practices, focusing on NLP methodology and evaluation. Through our investigation, we discovered a high variation regarding the reporting practices, such as inconsistent use of references for measurement studies, variation in the reporting location (reference, appendix, and manuscript), and different granularity of NLP methodology and evaluation details. To promote the wide adoption and utilization of NLP solutions in clinical research, we outline several perspectives that align with the six principles released by the World Health Organization (WHO) that guide the ethical use of artificial intelligence for health.
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Affiliation(s)
- Sunyang Fu
- Department of AI and Informatics Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Liwei Wang
- Department of AI and Informatics Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Sungrim Moon
- Department of AI and Informatics Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Nansu Zong
- Department of AI and Informatics Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Huan He
- Department of AI and Informatics Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Vikas Pejaver
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rose Relevo
- The National Center for Data to Health, Bethesda, Maryland, USA
| | - Anita Walden
- The National Center for Data to Health, Bethesda, Maryland, USA
| | - Melissa Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Hongfang Liu
- Department of AI and Informatics Research, Mayo Clinic, Rochester, Minnesota, USA
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Kim HS, Gweon TG, Park SH, Kim TH, Kim CW, Chang JH. Incidence and risk of pancreatic cancer in patients with chronic pancreatitis: defining the optimal subgroup for surveillance. Sci Rep 2023; 13:106. [PMID: 36596818 PMCID: PMC9810784 DOI: 10.1038/s41598-022-26411-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to present the incidence and risk factors for pancreatic cancer in a multicenter retrospective cohort of patients with chronic pancreatitis (CP). Patients with ICD-10 codes for CP (K86.0, K86.1) who underwent abdominal CT or MRI between January 2010 and December 2021 in seven academic hospitals were analyzed. After exclusions, we identified 727 patients with definite CP with a median follow-up of 3.6 years (range 1.0‒12.9). During 3290 person-years of observation, pancreatic cancers were diagnosed in 16 patients (2.20%, 0.49% per year) after a median follow-up of 2.4 years (range 1.4‒6.6), with an age- and sex-standardized incidence ratio of 18.1 (95% CI 10.4‒29.5). The underlying CPs in the 16 pancreatic cancers were classified as chronic obstructive pancreatitis (10, 63%), chronic obstructive and calcifying pancreatitis (4, 25%), chronic calcifying pancreatitis (1, 6%), and autoimmune pancreatitis (1, 6%). Factors associated with pancreatic cancer development included age (HR 4.830, p = 0.006), parenchymal calcification (HR 0.213, p = 0.003), pancreatic duct stricture (HR 2.706, p = 0.048), and serum CA 19‒9 level (HR 3.567, p = 0.014). After adjustment, age over 60 years (HR 4.540, p = 0.009) and serum CA 19‒9 levels greater than 100 U/mL (HR 3.528, p = 0.015) were independent risk factors for pancreatic cancer.
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Affiliation(s)
- Hyo Suk Kim
- grid.411947.e0000 0004 0470 4224Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Geun Gweon
- grid.411947.e0000 0004 0470 4224Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hi Park
- grid.411947.e0000 0004 0470 4224Institute of Clinical Medicine Research, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Tae Ho Kim
- grid.411947.e0000 0004 0470 4224Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Whan Kim
- grid.411947.e0000 0004 0470 4224Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hyuck Chang
- grid.411947.e0000 0004 0470 4224Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea ,grid.411947.e0000 0004 0470 4224Division of Gastroenterology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-Ro, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do 14647 Republic of Korea
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Ma DM, Dong XW, Han X, Ling Z, Lu GT, Sun YY, Yin XD. Pancreatitis and Pancreatic Cancer Risk. Technol Cancer Res Treat 2023; 22:15330338231164875. [PMID: 36972517 PMCID: PMC10052482 DOI: 10.1177/15330338231164875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Purpose: The present retrospective study aimed to explore the relationship between pancreatitis and pancreatic cancer in the population cohort of the UK Biobank (UKB) (https://www.ukbiobank.ac.uk). Methods: From the 500 thousand population cohort of UKB, according to the age and gender of patients with pancreatic cancer 1:10, matching the control without pancreatic cancer, the binary Logistic regression model was used to analyze the relationship between pancreatitis and pancreatic cancer, and subgroup analyses were used to identify potential effect modifiers. Results: A total of 1538 patients with pancreatic cancer were compared with 15 380 controls. In the fully adjusted model, patients with pancreatitis had a significantly increased risk of pancreatic cancer compared with no pancreatitis. The risk of pancreatitis and pancreatic cancer increased with the age of pancreatitis, and the risk of pancreatic cancer was highest in the 61 to 70 age group. In addition, in the first 3 years of acute pancreatitis, the risk of pancreatic cancer increased significantly with the increase in the duration of the disease (odds ratio [OR] 29.13, 95% confidence interval [CI]: 16.34-51.93), after 3 years, the trend of increase decreased. After more than 10 years, there was no significant correlation between the risk of acute pancreatitis and pancreatic cancer. However, patients with chronic pancreatitis were significantly associated with an increased risk of pancreatic cancer only in the first 3 years (OR 28.14, 95% CI: 14.86-53.31). Conclusion: Pancreatitis may associate with an increased risk of pancreatic cancer. The older the age of pancreatitis, the higher the risk of pancreatic cancer. The risk of pancreatic cancer increases significantly in the first 3 years of the course of pancreatitis. This may provide an alternative strategy for the early identification of individuals at high risk of pancreatic cancer.
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Affiliation(s)
- Dong-Mei Ma
- Department of Oncology, 587863Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xiao-Wu Dong
- Pancreatic Center, 587863Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Diseases, Yangzhou, China
| | - Xiao Han
- Department of Oncology, 587863Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhi Ling
- Department of Oncology, 587863Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Guo-Tao Lu
- Pancreatic Center, 587863Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Diseases, Yangzhou, China
| | - Yun-Yun Sun
- Pancreatic Center, 587863Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Diseases, Yangzhou, China
| | - Xu-Dong Yin
- Department of Oncology, 587863Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
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Luong TQ, Chen Q, Tran TM, Zhou Y, Lustigova E, Chen W, Wu BU. Clinical and Imaging Predictors of Pancreatic Cancer in Patients Hospitalized for Acute Pancreatitis. GASTRO HEP ADVANCES 2022; 1:1027-1036. [PMID: 39131243 PMCID: PMC11308526 DOI: 10.1016/j.gastha.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/12/2022] [Indexed: 08/13/2024]
Abstract
Background and Aims Identifying factors associated with increased short-term risk of pancreatic cancer in the setting of acute pancreatitis (AP) can inform clinical care decisions and expedite cancer diagnosis. Methods A retrospective cohort study of patients hospitalized for AP between 2007 and 2017 in an integrated health-care system in Southern California. AP cases were identified by diagnosis code with laboratory confirmation. Multivariable Cox proportional hazards regression model was used to assess risk of pancreatic cancer within 3 years of AP, adjusting for patient demographics, clinical parameters (body mass index, AP etiology, chronic pancreatitis, diabetes) and radiographic imaging features. Results Among 9,490 patients hospitalized with AP, the mean (standard deviation) age was 55.8 (17.8) years, 55% were women, and 42% were Hispanic. Majority of AP cases were biliary (64%), 12% were alcohol-related, 5% were hypertriglyceridemia-induced, and 19% were other/unknown etiology. Ninety-five (1%) patients were diagnosed with pancreatic cancer within 3 years of AP (4.2 cases/1000 person-years). Risk factors for pancreatic cancer were age ≥65 years (hazard risk [HR]: 2.5, 95% confidence interval [CI]: 1.2-5.3), male sex (HR: 1.9, 95% CI: 1.2-2.8), Asian/Pacific Islander race (HR: 2.0, 95% CI: 1.1-3.6), and underweight body mass index (HR: 2.6, 95% CI: 1.1-6.5). In addition, other/unknown AP etiology (HR: 2.0, 95% CI: 1.3-3.1) and dilatation of the main pancreatic duct (HR: 6.6, 95% CI: 4.2-10.5) were independently associated with increased risk of pancreatic cancer. Conclusion In addition to older age, the lack of well-established etiology, underweight body habitus, and main pancreatic duct dilatation were independently associated with increased short-term risk of pancreatic cancer among patients hospitalized for AP.
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Affiliation(s)
- Tiffany Q. Luong
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Qiaoling Chen
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Tri M. Tran
- Department of Internal Medicine, Southern California Permanente Medical Group, Los Angeles, California
| | - Yichen Zhou
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Eva Lustigova
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Wansu Chen
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California
- Department of Gastroenterology, Southern California Permanente Medical Group, Los Angeles, California
| | - Bechien U. Wu
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California
- Department of Gastroenterology, Southern California Permanente Medical Group, Los Angeles, California
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Chen W, Chen Q, Parker RA, Zhou Y, Lustigova E, Wu BU. Risk Prediction of Pancreatic Cancer in Patients With Abnormal Morphologic Findings Related to Chronic Pancreatitis: A Machine Learning Approach. GASTRO HEP ADVANCES 2022; 1:1014-1026. [PMID: 36467394 PMCID: PMC9718544 DOI: 10.1016/j.gastha.2022.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS A significant factor contributing to poor survival in pancreatic cancer is the often late stage at diagnosis. We sought to develop and validate a risk prediction model to facilitate the distinction between chronic pancreatitis-related vs potential early pancreatic ductal adenocarcinoma (PDAC)-associated changes on pancreatic imaging. METHODS In this retrospective cohort study, patients aged 18-84 years whose abdominal computed tomography/magnetic resonance imaging reports indicated duct dilatation, atrophy, calcification, cyst, or pseudocyst between January 2008 and November 2019 were identified. The outcome of interest is PDAC in 3 years. More than 100 potential predictors were extracted. Random survival forests approach was used to develop and validate risk models. Multivariable Cox proportional hazard model was applied to estimate the effect of the covariates on the risk of PDAC. RESULTS The cohort consisted of 46,041 (mean age 66.4 years). The 3-year incidence rate was 4.0 (95% confidence interval CI 3.6-4.4)/1000 person-years of follow-up. The final models containing age, weight change, duct dilatation, and either alkaline phosphatase or total bilirubin had good discrimination and calibration (c-indices 0.81). Patients with pancreas duct dilatation and at least another morphological feature in the absence of calcification had the highest risk (adjusted hazard ratio [aHR] = 14.15, 95% CI 8.7-22.6), followed by patients with calcification and duct dilatation (aHR = 7.28, 95% CI 4.09-12.96), and patients with duct dilation only (aHR = 6.22, 95% CI 3.86-10.03), compared with patients with calcifications alone as the reference group. CONCLUSION The study characterized the risk of pancreatic cancer among patients with 5 abnormal morphologic findings based on radiology reports and demonstrated the ability of prediction algorithms to provide improved risk stratification of pancreatic cancer in these patients.
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Affiliation(s)
- Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Qiaoling Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Rex A. Parker
- Department of Radiology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, California
| | - Yichen Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Eva Lustigova
- Department of Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California
| | - Bechien U. Wu
- Department of Gastroenterology, Center for Pancreatic Care, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, California
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Gandhi S, de la Fuente J, Murad MH, Majumder S. Chronic Pancreatitis Is a Risk Factor for Pancreatic Cancer, and Incidence Increases With Duration of Disease: A Systematic Review and Meta-analysis. Clin Transl Gastroenterol 2022; 13:e00463. [PMID: 35142721 PMCID: PMC8963838 DOI: 10.14309/ctg.0000000000000463] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Observational studies have suggested an increased risk of pancreatic ductal adenocarcinoma (PDAC) in patients with acute and chronic pancreatitis. We conducted a systematic review and meta-analysis to evaluate the magnitude of this association and summarize the published epidemiological evidence. METHODS We searched electronic databases (MEDLINE, Embase, Web of Science, Cochrane, and Scopus) and reference lists until January 18, 2021. Studies reporting quantitative association between pancreatitis and PDAC were included and assessed for eligibility, data abstraction, and risk of bias. Standardized incidence ratios (SIRs) were pooled using the random-effects model. RESULTS Twenty-five cohort and case-control studies met inclusion criteria. Meta-analysis of 12 chronic pancreatitis (CP) studies demonstrated an increased risk of PDAC in patients with CP (SIR: 22.61, 95% confidence interval [CI]: 14.42-35.44). This elevated risk persisted in subgroup analysis of studies that excluded patients diagnosed with PDAC within 2 years of CP diagnosis (SIR: 21.77, 95% CI: 14.43-32.720). The risk was higher in hereditary pancreatitis (SIR: 63.36, 95% CI: 45.39-88.46). The cumulative incidence rates of PDAC in CP increased with follow-up duration. Limited evidence in acute pancreatitis indicates higher PDAC risk in the subset of patients eventually diagnosed with CP. PDAC seems to be uncommon in patients with autoimmune pancreatitis, with 8 reported cases in 358 patients with autoimmune pancreatitis across 4 studies. DISCUSSION There is an increased risk of PDAC in patients with CP, and incidence rates increase with CP disease duration. Our results indicate that PDAC surveillance may be considered in individuals with long-standing CP.
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Affiliation(s)
- Sonal Gandhi
- Department of Medicine, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jaime de la Fuente
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shounak Majumder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Umans DS, Hoogenboom SA, Sissingh NJ, Lekkerkerker SJ, Verdonk RC, van Hooft JE. Pancreatitis and pancreatic cancer: A case of the chicken or the egg. World J Gastroenterol 2021; 27:3148-3157. [PMID: 34163103 PMCID: PMC8218365 DOI: 10.3748/wjg.v27.i23.3148] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/13/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer are three distinct pancreatic diseases with different prognoses and treatment options. However, it may be difficult to differentiate between benign and malignant disease. AP may be a first symptom of pancreatic cancer, particularly in patients between the ages of 56 and 75 with presumed idiopathic AP who had a concomitant diagnosis of new-onset diabetes mellitus or patients who present with CP at diagnosis of AP. In these patients, additional imaging is warranted, preferably by endoscopic ultrasonography. CP may lead to pancreatic cancer through oncogenic mutations, mostly in patients with hereditary CP, and in patients in whom risk factors for pancreatic cancer (e.g., nicotine and alcohol abuse) are also present. Patients with PRSS1-mediated CP and patients with a history of autosomal dominant hereditary CP without known genetic mutations may be considered for surveillance for pancreatic cancer. Pancreatic inflammation may mimic pancreatic cancer by appearing as a focal mass-forming lesion on imaging. Differentiation between the above mentioned benign and malignant disease may be facilitated by specific features like the duct-penetrating sign and the duct-to-parenchyma ratio. Research efforts are aimed towards developing a superior discriminant between pancreatitis and pancreatic cancer in the form of imaging modalities or biomarkers. This may aid clinicians in timely diagnosing pancreatic cancer in a potentially curable stage.
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Affiliation(s)
- Devica S Umans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam 1105 AZ, The Netherlands
- Department of Research and Development, St. Antonius Hospital, Nieuwegein 3430 EM, The Netherlands
| | - Sanne A Hoogenboom
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam 1105 AZ, The Netherlands
| | - Noor J Sissingh
- Department of Research and Development, St. Antonius Hospital, Nieuwegein 3430 EM, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Selma J Lekkerkerker
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam 1105 AZ, The Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein 3430 EM, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
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13
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Jeon CY, Feldman R, Althouse A, AlKaade S, Brand RE, Guda N, Sandhu BS, Singh VK, Wilcox CM, Slivka A, Gelrud A, Whitcomb DC, Yadav D. Lifetime smoking history and cohort-based smoking prevalence in chronic pancreatitis. Pancreatology 2021; 21:S1424-3903(21)00473-7. [PMID: 34116939 PMCID: PMC8628024 DOI: 10.1016/j.pan.2021.05.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Smoking prevalence in patients with chronic pancreatitis [CP] is high. We aimed to understand lifetime history of smoking and cohort trends in CP patients to inform effective strategies for smoking cessation. METHOD Data on 317 CP patients from the North American Pancreatitis Study 2 [NAPS2] Continuation and Validation Study and the NAPS2 Ancillary Study were analyzed. Smoking history was assessed for each phase of life from the onset of smoking to study enrollment. Data on second-hand smoke and drinking history were also collected. We compared demographic factors, drinking history, pain level and pancreas morphology by smoking status at age 25 (non-smoking, <1 pack per day [PPD], ≥1 PPD). We compared smoking prevalence by birth cohorts: 1930-1949, 1950-1969, 1970-1989. RESULT Fifty-one percent of CP patients reported smoking at the time of enrollment. Those who smoked ≥1 PPD at age 25 smoked a cumulative total of 30.3 pack-years of cigarettes over a lifetime. Smoking at age 25 was associated with greater lifetime drinking and greater exposure to second-hand smoke at home and at workplace. Pancreatic atrophy and pseudocysts were more common among smokers. Pancreatic pain was more severe among smokers, and 12-13% of smokers reported smoking to alleviate pain. Male CP patients born in 1950-1969 reported the highest peak prevalence of smoking, and female CP patients born in 1970-1989 reported highest peak prevalence of smoking. CONCLUSION CP patients exhibit intense and sustained smoking behavior once established in the 20s. Regardless, cohort analyses demonstrate that the behaviors could potentially be altered by policy changes.
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Affiliation(s)
- Christie Y Jeon
- Cedars Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Robert Feldman
- Center for Research on Healthcare Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew Althouse
- Center for Research on Healthcare Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nalini Guda
- Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | | | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - C Mel Wilcox
- Division of Gastroenterology and Hepatology, University of Alabama Birmingham, AL, USA
| | - Adam Slivka
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Kenner B, Chari ST, Kelsen D, Klimstra DS, Pandol SJ, Rosenthal M, Rustgi AK, Taylor JA, Yala A, Abul-Husn N, Andersen DK, Bernstein D, Brunak S, Canto MI, Eldar YC, Fishman EK, Fleshman J, Go VLW, Holt JM, Field B, Goldberg A, Hoos W, Iacobuzio-Donahue C, Li D, Lidgard G, Maitra A, Matrisian LM, Poblete S, Rothschild L, Sander C, Schwartz LH, Shalit U, Srivastava S, Wolpin B. Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review. Pancreas 2021; 50:251-279. [PMID: 33835956 PMCID: PMC8041569 DOI: 10.1097/mpa.0000000000001762] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Despite considerable research efforts, pancreatic cancer is associated with a dire prognosis and a 5-year survival rate of only 10%. Early symptoms of the disease are mostly nonspecific. The premise of improved survival through early detection is that more individuals will benefit from potentially curative treatment. Artificial intelligence (AI) methodology has emerged as a successful tool for risk stratification and identification in general health care. In response to the maturity of AI, Kenner Family Research Fund conducted the 2020 AI and Early Detection of Pancreatic Cancer Virtual Summit (www.pdac-virtualsummit.org) in conjunction with the American Pancreatic Association, with a focus on the potential of AI to advance early detection efforts in this disease. This comprehensive presummit article was prepared based on information provided by each of the interdisciplinary participants on one of the 5 following topics: Progress, Problems, and Prospects for Early Detection; AI and Machine Learning; AI and Pancreatic Cancer-Current Efforts; Collaborative Opportunities; and Moving Forward-Reflections from Government, Industry, and Advocacy. The outcome from the robust Summit conversations, to be presented in a future white paper, indicate that significant progress must be the result of strategic collaboration among investigators and institutions from multidisciplinary backgrounds, supported by committed funders.
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Affiliation(s)
| | - Suresh T. Chari
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - David S. Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen J. Pandol
- Basic and Translational Pancreas Research Program, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Anil K. Rustgi
- Division of Digestive and Liver Diseases, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | | | - Adam Yala
- Department of Electrical Engineering and Computer Science
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Noura Abul-Husn
- Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Marcia Irene Canto
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yonina C. Eldar
- Department of Math and Computer Science, Weizmann Institute of Science, Rehovot, Israel
| | - Elliot K. Fishman
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD
| | | | - Vay Liang W. Go
- UCLA Center for Excellence in Pancreatic Diseases, University of California, Los Angeles, Los Angeles, CA
| | | | - Bruce Field
- From the Kenner Family Research Fund, New York, NY
| | - Ann Goldberg
- From the Kenner Family Research Fund, New York, NY
| | | | - Christine Iacobuzio-Donahue
- David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debiao Li
- Biomedical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Anirban Maitra
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Lawrence H. Schwartz
- Department of Radiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Uri Shalit
- Faculty of Industrial Engineering and Management, Technion—Israel Institute of Technology, Haifa, Israel
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Brian Wolpin
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA
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